Nov. 7, 1896.] ZONA BELOW THE KNEE.
[XuL-w'z 1379
FILARIASIS IN SAMOA.
By PATRICK MANSON, M.D., F.R.C.P.,
Physician to the Seamen's Hospital, Albert Docks.
As a supplement to Surgeon V. Gunson Thorpe's interesting
paper on filariasis in the South Sea Islands (BRITISH MEDICAL
JOURNAL, October 3rd, I896), I wish to record the result of
the examination of certain blood films kindly sent to me
from Samoa by Dr. Davies in 1884. The films were 56 in
number and represented the evening blood of 56 adult
Samoans, each of whom was affected by some form or other
of elephantoid disease, either elephantiasis, or elephantoid
eryeipelas, or lymphangitis, or recurrent elephantoid fever.
Of the 56 slides 27 contained filariae, 29 had no filariae. In
some slides-each equivalent to about half a drop of blood-
only from i to IO parasites, in others from 30 to ioo were
found. In not a few they were present in enormous numbers;
4 contained i6J, 132, 165, and 232 filariie respectively, and in
one slide, by no means a large one, I counted no fewer than
566 filariae.
It is evident, therefore, that filariasis is quite as common in
Samoa as it is in Fiji and the Friendly Islands, if not more
so. Unfortunately, Dr. Davies's slides were in a measure
selected, coming entirely from that part of a filariated com-
munity least likely to show filari2e in the blood-namely, from
the subjects of elephantiasis, that is of filaria-blocked lym-
phatics. Elsewhere I have endeavoured to show that such
individuals are the least likely to have filariae in the blood,
seeing that the disease to which the parasite gives rise cuts
its progeny off from the circulation. I have little doubt,
therefore, in view of the enormous proportion of elephantiasis
cases in Samoa, showing filarire in the blood, that further in-
vestigation of the healthy adult population will bring.out the
startling fact that practically all adult Samoans harbour
filaria nocturna, or are the subjects of filaria disease.
WARM BATHS IN THE TREATMENT OF
MEASLES.
By C. J. RIX, M.R.C.S.ENG., L.M. AND L.S.A.LOND.,
Soutlhsea.
SOME eight or ten years ago, being called to a child supposed
to be suffering from bronchitis, the breathing being greatly
affected, I ordered the usual linseed-meal poultices back and
front. The result was to bring out a rash upon the poulticed
parts, unequivocally showing measles, none of the ordinary
premonitory symptoms of that disease, except the pulmonary
trouble, having previously appeared. Seeing this I had the
patient placed up to the neck in a hot bath of 9o° to ioo° F.,
or as hot as could be borne without pain, in front of a good
fire, screened from all draughts, and kept there for some 6,
8, or io minutes. Even whilst in the water, the rash could
be seen extending over the rest of the body, after removal
from the bath he was roughly dried, wrapped in a warmed
blanket (without bedelothing), and put into bed. The breath-
ing. gradually became easier, and in a short time he was
asleep. The bath was repeated twice daily for the first two or
three days; in about ten days the case was well.
It has since been my invariable practice to order a hot bath
immediately the diagnosis of measles has been made, and
often before, if any suspicions of the disease were aroused,
though not confirmed. After the bath the patient is dried
roughly and wrapped in a warmed blanket. I repeat the
baths every twelve hours, or oftener in obstinate cases (some-
times as many as five and six a day), until the rash is fully
developed over the entire body, and continue them twice
daily until a normal temperature is re-established, and then
once daily, generally in the evening, during the whole of the
attendance, which I find rarely if ever extends over ten days.
The course of the disease is shortened, the tendency to
respiratory and renal complications lessened, if not practically
removed, at the same time it is very seldom that any of the
usual sequelse supervene, if they do it is only in the very
slightest possible degree.
I have now adopted this treatment for the last eight years,
in combination with isolation in a well ventilated room,
having a sheet over the outside of the door sprinkled with a
solution of carbolic acid in the usual way. I have generally
succeeded in restricting the infection to the one case, even
when the families numbered some five or six children. And
of these first cases, I can unhesitatingly assert that 99
per cent. were well on the tenth or elventh day, and if the
weather favourable, out on the twelfth day.
Some mothers, or grandmothers, make great difficulties,
owing, I believe, to the old superstition " that measles must
not be touched with water." But whenever I have been able
to ensure that my directions were thoroughly carried out.
there has always been a successful termination, and I have
never found any real necessity to prescribe active medicines
even for relieving the cough, which gradually subsides as the
case recovers.
Having recently read of the application of the milkpack in
the treatment of eruptive fevers, I have in several cases
added from half to a full gallon of milk to the first bath (as a
modffication of the milkpack treatment in which the patient
has also to submit to a warm bath after the Packing). I have
carefully noted the effects of the two methods; namely, of hot
baths with, and hot baths without milk, in cases under treat-
ment at the same time; the results were practically iden-
tic 1.
Having only this year had quite an epidemic of measles
in these parts, I have been able to confirm the above remarks.
In every case that has come under my care, and they have
been numerous, the treatment has been successful where it
has been u4eid, and this fact it is which has emboldened me
to make known my experience.
I would suggest a trial of this treatment in other diseases,
as scarlet fever and small-pox, in which, on account of the
prompt action of the sanitary authorities, I have had- no
opportunity of properly testing. But, as with measles I have
no doubt that this plan of assisting Nature in the eiimina-
tion of the virus would give favourable results, and not only
greatly tend to lessen the mortality, but also minimise the
risk of the infection or contagion spreading.
1 always add a disinfectant to the bath after use.
I never allow the head of the patient to be wetted when
giving the baths: the hair takes long to dry thoroughly. The
chance of a chill, which is to be carefully avoided, is thus
diminished.
ON THE OCCURRENCE OF ZONA BELOW THE
KNEE, WITH NOTES OF TWO CASES.
By R. B. MAHON, M.D., F.R.C.S.,
Medical Officer,iUnion Infirmary and Fever Hospital, Ballinrobe.
THE great rarity of recorded cases of herpes zoster occurring
or extending below the knee is evident from the scant mention
of the condition in the leading textbooks on diseases of
the skin. Even in Kaposi's great work the subject iserup- dis-
missed in a few lines. In Fox's Atlas, plate xxvii, the the
tion does not extend below the junction of the upper with Mr.
middle third of the leg. According to Dr. Pye-Smith," and
Hutchinson says that it never extends below the knee,
the only instance to the contrary is one figured by von
BiLrensprung in which there were a few small papules as low
as the middle of the calf."'
In an able paper in the Journal of Patholoqy and Bacteriology,
February, 1893, p. 343, Dr. James Mackenzie says, "accurate He
reports of cases of eruption below the knee are scarce."
quotes a case described by Blake in the Birmingham Medical
Review, the eruption being over the inner side of the leg below
the middle of the calf, tie inner ankle and the dorsal and
plantar surfaces of the foot representing probably the areaby of
distribution of the fifth lumbar nerve. A case described in
1889,
Taylor in the BRITISH MEDICAL JOURNAL, July 6th, internal
which the eruption extended " along the course of the Acase
inner ankle."
saphenousnervefrombelow the knee to thevesicles
is mentioned by Charcot,2 the herpetic being seated
on "the antero-external surface of the left leg," the subse-
1 Fagge alid Pye-Smith, Prnciples and Practice of Medicine, 3rd edition,
p. 938.
2 Maladies du Systeme&Ne,.veux.